Author Information

Nirmanmoh Bhatia,

Eric Thomassee,

Carol Scott and

Joseph Fredi

Vanderbilt University Medical Center, Nashville, TN

Background

Gender disparities have been observed in ST elevation myocardial infarction (STEMI) patients with women experiencing lengthier reperfusion times. There is limited data about persistence of these discrepancies in the current era in a real world setting.

Methods

A retrospective analysis of our institutional STEMI network database was done to include all patients with complete metrics from January 2009 to July 2015 who were transferred to our center with STEMI. Multiple imputation was used to account for any missing data. Patients were stratified based on gender to compare patient characteristics, outcomes, and quality measures.

Results

A total of 632 patients (132 women) were included in the analysis. Women were older (62.5 ± 13.5 vs. 59.3 ± 12.3 years, p < 0.05) but there was no difference in other demographics and pre-existing co-morbidities. Women were transferred over longer distances (43.2 ± 22.3 vs. 38.8 ± 23.9 miles, p = 0.05). Female gender was associated with a higher time to activation of cardiac catheterization laboratory (53.1 vs. 37.2 minutes, p < 0.05), but there was no difference in door-to-(electrocardiogram) EKG-time (17.1 vs. 13.5 minutes, p > 0.05), door-in door-out (DIDO) time (110 vs. 91 minutes, p > 0.05), transportation time (36.2 vs. 32.9 minutes, p > 0.05), first medical contact to balloon time (182.6 vs. 159.3 minutes, p > 0.05) or total procedure time (36.2 vs. 35.8 minutes, p > 0.05). Women were more likely to present with systolic blood pressure < 100 mmHg (6% vs. 3%, p = 0.05), femoral access was used more often in women (39.3% vs. 20%, p < 0.001), norepinephrine was used more frequently in women (9% vs. 4%, p < 0.05) but there was no difference in the use of other vasopressors, inotropes or mechanical circulatory support. On univariate analysis, in hospital mortality was higher in women (10% vs. 5%, p < 0.05) but after adjusting for confounders, gender was no longer associated with higher mortality (adjusted odds ratio, 1.3; 95% CI, 0.6-2.9, p > 0.05). On linear regression, female gender, longer door-to-EKG time, longer transfer distance and longer DIDO time were the independent predictors of longer time to activation of catheterization laboratory (R2=0.79, p < 0.0001).

Conclusion

Data from a single STEMI network suggests that in the current era in a real world setting, women transferred for STEMI may have longer time to activation of cardiac catheterization laboratory than men. There is a need to further streamline systems and improve quality measures in STEMI networks, especially for women.